 

Dear Resident 

Welcome to the Emergency Department at Childrens Hospital and Research Oakland (CHRCO)! 

 

The ED at CHRCO is an exciting, educational, hands-on opportunity to care for children. It 
can be a fast-paced environment with multiple things occurring simultaneouslywe hope you will 
maximize your exposure to the various medical problems, levels of acuity, procedures, and needs of 
the patients and families you will evaluate. 

The attendings, fellows, nurses, and support staff are always available to answer any 
question--dont hesitate to ask. 

In this document are orientation materials to help you get started and transition into the 
system. In addition are general goals and objectives that have been written for the rotation. Take 
some time to think about how these apply to you and to create personal objectives as well. 

On the hard drive of each computer in the ED is a folder of core pediatric emergency 
medicine articles for you to read and reference; we hope this will be a useful addition to the current 
resources you use. 

 

Enjoy the rotation! Please let us know your feedback so we can continue to improve the experience. 

 

Contents: 

Orientation Checklist, page 2 

Guide to Charting, page 3 

Meditech pocket guide, page 4 

Goals and Objectives (Part I and II), pages 5-25 



CHRCO ED Orientation ChecklistPlease go through this checklist with an attending/fellow/or senior 
resident on your first day. 

1) Tour of the Department 
a. Chart carousel 
b. Resuscitation/Trauma rooms with general familiarity of equipment 
i. Partial/Full trauma 


c. Triage 
d. File cabinet with charts from past month 
e. Supply room (suture cart, splinting material, etc.) 
f. Medication room (eyebox, procedural sedation forms) 




**Make sure to label all medications before leaving the med room 

 Prelabeled stickers available for lidocaine syringes 

2) Key personnel 
a. Ward clerk (where to place orders) 
b. Respiratory Therapy (RT order sheet, calling for treatments) 
c. CCST (role, how to reach them) 
d. Social Work 
e. Spanish interpreter (evenings, other times/languages use phone) 


3) Computers 
a. MediTech and Tracking (see Pocket Guide) 
i. Go over different columns, especially acuity, wait time, and referred by PMD 


b. Radiology iSite (radiologists put in official reads for all studies during day, until 10pm for 
CTs, and after hours CT reads are faxed to ED by nighthawk service) 
c. MDConsult.com and/or CRS for discharge instructions 
d. CHOnet for drug formulary (Lexicomp) 
e. Orientation folder with articles 


4) Telephone 
a. Page only to 3240 (main ED number) 
b. Ward clerk will announce over head what extension call is parked 
i. Picking up a parked call: 172 then extension number 


c. Do not give patient advice over the phone 


5) Resuscitation resident 
6) AM didactic (resident assigned for that day should be familiar with subject matter, and 
attending should lead a case-based discussion of the topic); Thurs AM is mock code 
7) SAFE team (SAM/Kempes), BERT 
8) Guide to charting (see separate handout) 
a. PMD expects will be attached to chart. Be sure to call PMDs 




*especially if requested at time of referral (will be noted on expect form) 


CHRCO ED Guide to charting 

Goal: adequate medical documentation, adherence to JCAHO guidelines, and accurate billing. 

Most commonly missed areas on main chart: 

1) Sign and date your charts immediately (so incomplete charts can be given to correct resident) 
2) Evaluation time (and timed updates throughout chart) 
3) Review check boxes: allergies, reviewed nursing notes, interpreter (add name of interpreter) 
4) HPI (Did you know that at least 4 elements of HPI are needed to be complete?) 
5) ROS: This is necessary for complete care 
a. Must circle those that are positive, check all negatives related to the presenting 
problem, before checking All others negative 


6) Checking noncontributory for Past medical/social/and family is not enough (please add detail) 
7) Using an interpreter 
a. Note name of interpreter (or use of interpreter phone service) 
b. Checking who you interviewed documents higher complexity of patient encounter 


8) Document name and time paged for consultation requests 


Procedure note: 

. Do a time out for the Universal Protocol before major procedures. 
. Special pre-printed form for most common procedures. Take care to fill in all appropriate boxes. 


 

Discharge Instructions: 

. To be written in lay terminology. Pre-printed discharge instructions, Pediatric Advisor 
Index(online), should also be used often (and should be documented on discharge form), but 
also write specific information. 
. Asthma action plan (for those with asthma) 


 

Discharge medications/Medication Reconciliation Form: 

. Prescriptions (including, license number, DEA, NPI, and number of total meds on prescription) 
. Write down any over-the-counter you suggest or controlled substances that you Rx 
o Controlled substance prescriptions in attending office 


. Review list of home medications: check yes/no/change for home medications 
. Sign (all forms, even if no medications) 


 


CHRCO ED MediTech Pocket Guide 

 

Getting started 

Adding your name to the screen 

 G  RES  <Enter> x 3  E  <Enter> 

 Add name, mnemonic, and shift time -- <F12> x 2 

 

To begin to see a patient (do this before you go into room) 

 Select patient [with up and down arrows] 

 A  S  S  <F12> [changes pt color from blue to off] 

 

Reassigning a resident to a patient 

 A  E  your mnemonic -- <Enter> 

 

Changing nurse color to red after you write an order 

(only for orders not intiated by ward clerk) 

 A  N  <Enter>  R  <F12> 

 *Also best to talk face-to-face 

 

Flag patient for discharge by nurse 

 First complete discharge paperwork and put in rack 

 A  S  DC  <F12> 

 

Patient color 

 Blue: waiting to be seen by resident 

 Red: to be seen ASAP, urgent 

 Lavender: admit 

 Green: ready for discharge 

 White: in x-ray 

 

Reviewing patient information 

Select patient [up and down arrows] 

 M  P  < . > 

 *NEW* RECENT CLINICAL RESULT (new lab results) 

 VISIT HISTORY (Check recent ED or outpatient visits) 

 LABORATORY/MICROBIOLOGY (To see previous labs and 

 if current specimens received) 

Ordering medications 

Select patient [up and down arrows] 

M  O  1  <Enter> 

 

<space>  <F12>  Y  <Enter> [selects the current patient] 

<C>  <Enter> (to continue) 

ORDERING Dr: <your name mnemonic>  <Enter> 

CATEGORY: PHA  <Enter> 

PROCEDURE: (Option 1) ED  <F9> (ED medication order set) 

 (Option 2) <first few letters of med name>  <F9> 

 (Option 3) <OTHER> (if you cant find the medication) 

 Then use up and down arrows and <F12> to select 

 

Hit <Enter> multiple times until you are at 

Wt (kg): Enter weight in kg [ ] 

Allergies: [Y] in appropriate box 

Hit Enter until at the [ ] for the medication choice you want 

[ ]: [Y] at order you want and Enter dose 

F12 to finish 


Emergency Medicine Residents Goals and Objectives 

 

 

PGY-1/2 

PGY-3 

PGY-4 

Professionalism Commitment to carrying 
out professional responsibilities, adherence 
to ethical principles, and sensitivity to a 
diverse patient population. 

Be professional and ethical in your interactions with patients, 
families, and co-workers. Through your training, these behaviors 
should increase; a senior resident should be an example and teacher 
to junior residents. 

Medical Knowledge Application of 
established and evolving biomedical, 
clinical, and scientific knowledge to patient 
care. 

Familiarize yourself with sections III. Common Signs and Symptoms, 
IV. Common Conditions, and V. Diagnostic Testing in the document 
Part II. Educational Goals and Objectives for the ED at CHRCO prior 
to each time you rotate at the CHRCO ED; seek knowledge in these 
topics through clinical experience and self-directed reading. Give 
special attention towards learning topics with which youve not had 
experience or are unfamiliar. 

o Knowledge of differential 
diagnoses 
o PEM-specific knowledge of 
diseases 




Gain a basic 
knowledge of 
sections III-IV 
through clinical 
experiences, 
didactics, and self-
directed reading. 

Begin to gain 
advanced knowledge 
of other topics in 
sections III-IV. Have 
an advanced 
knowledge of the 
differentials for fever 
in various age 
groups, abdominal 
pain, respiratory 
distress, and the ill-
appearing infant. 

Have an advanced 
knowledge of 
sections III-IV. 

o Choosing diagnostic tests and 
making management plans 
o Synthesis of knowledge 




Basic knowledge of 
section V. Always 
independently 
formulate a 
diagnostic and 
management plan. 
Implement that plan 
after receiving 
guidance from the 
attending or fellow. 

Work towards an 
advanced knowledge 
of section V. Always 
independently 
formulate a 
diagnostic and 
management plan. 
Develop comfort in 
implementing these 
plans with minimal 
guidance from 
attending and 
fellows. 

Advanced 
knowledge of 
section V. 
Demonstrate to 
attendings and 
fellows the ability to 
independently 
synthesize clinical 
information, choose 
diagnostic tests and 
create management 
plans. 

Patient Care Treat health problems and 
promote health in a compassionate, 
appropriate, and effective manner. 

 

o Initial assessment of vitals and 
severity of illness 




Prior to obtaining history always make an initial assessment of vitals 
and severity of illness. Reassess pertinent abnormal vital signs 
during physical exam. 

 

Immediately 
recognize severely ill 
patients and bring 
an attending or 
fellow to the 
bedside. Recognize 

Recognize 
moderately and 
severely ill patients 
and initiate 
management plans. 
Involve the fellow or 

Independently 
recognize and treat 
moderately and 
severely ill patients. 
Alert the fellow or 
attending of the 




moderately ill 
patients and under 
the guidance of a 
fellow or attending 
initiate management 
plans early. 
Recognize that this 
may need to be prior 
to obtaining 
comprehensive Hx 
and PE. 

attending early in the 
management of the 
patient. 

presence of severely 
ill patients, and 
what your plan of 
management has 
been/will be. 

o Systematic approach to 
History (Hx) and physical 
exam (PE) 




Develop a systematic approach to a directed Hx and PE. Junior 
residents should ask for guidance from an attending, fellow, or 
senior resident in improving skills at the bedside. 

o Continuing 
management/reassessment 
of patients 




Continually reassess 
the clinical status of 
all your patients (in 
particular after tests 
results are available, 
clinical interventions 
have been done, or a 
long period of 
waiting). 

Improve in your 
ability to continually 
reassess the clinical 
status of all your 
patients (in particular 
after tests results are 
available, clinical 
interventions have 
been done, or a long 
period of waiting). 

In addition to 
reassessing ones 
own patients, senior 
residents should be 
mindful of the 
whole ED 
environment and 
remind and help 
junior residents 
reassess and update 
their patients. 

o Leading a 
resuscitation/trauma 




Attend all pediatric 
resuscitations and 
traumas (as clinical 
work allows) to be a 
member of the 
resuscitation team, 
and to watch how 
the team leader is 
running the 
resuscitation. 

You will be assigned 
the role of 
RESUSCITATION 
resident. Take the 
lead and be able to 
systematically 
organize, lead, and 
implement a plan 
during a pediatric 
resuscitation with 
the guidance of an 
attending or fellow. 

You will be assigned 
the role of 
RESUSCITATION 
resident. Take the 
lead and be able to 
systematically 
organize, lead, and 
implement a plan 
during a pediatric 
resuscitation in an 
independent 
fashion using the 
attending as back-
up as needed. 

o Procedural skills 




Read about all procedures in Section II, V, and VI. 

 

Know how and begin 
to perform basic 
pediatric procedures 
under the guidance 
of staff, attending or 
fellow (urinary 
catheterization, IV 
placement, 
laceration repair, 
splinting, lumbar 
puncture, bag-valve 

Demonstrate 
performance of basic 
procedures (listed to 
the left) with minimal 
guidance from an 
attending or fellow. 
Begin to develop 
proficiency in 
remaining 
procedures in 
sections II,V, and VI. 

Be able to 
independently 
perform procedures 
in sections II, V, and 
VI with minimal 
guidance from the 
attending. 




mask ventilation, 
chest compressions) 

Interpersonal and Communication Skills 
Effectively team with and exchange 
information with patients, families, and 
other health professionals. 

1) Strive towards succinct, goal-directed, and courteous 
communications with your team of co-workers and 
consultants. 
2) Continually communicate with families so that they 
understand their experience in the ED. They should always 
know who you are, what they plan is, and what they are 
waiting for. If they are discharged, you should give an 
understanding of their probable diagnosis, its management, 
follow-up care, and signs that they should return to the ED. 


o Presenting to an 
attending/fellow 




Develop a 
systematic approach 
towards patient 
presentation that 
includes Hx, PE, 
discussion of 
differential and 
management 
options. 

Improve upon your 
systematic approach 
by mastering the 
presentation of 
pertinent elements. 

Succinctly present 
the pertinent Hx, 
PE, differential and 
management with 
minimal need for an 
attending or fellow 
to clarify or 
intervene. 

o Calling consults 




Call consultants only 
after discussion with 
an attending or 
fellow. When calling 
a consult understand 
the indication, make 
a list of the clinical 
questions, and give 
the appropriate 
patient information. 

Let an attending or 
fellow know when 
you are going to call 
a consultant. With 
help from the 
attending, 
understand the 
indication for 
consultation, 
formulate and 
present an initial 
plan, and give the 
pertinent 
information 
succinctly. 

Let an attending or 
fellow know when 
you are going to call 
a consultant. Be 
able to 
independently 
formulate a 
comprehensive plan 
prior to calling the 
consultant and give 
the pertinent 
information 
succinctly. 

Practice-Based Learning and Improvement 
Investigate and evaluate ones own patient 
care, appraisal and assimilation of scientific 
evidence, and improvements in patient 
care. 

Use and appraise the literature to add to and enhance clinical 
management. 

 

o Seek out feedback and self-
evaluate 
o Receive and incorporate 
feedback 




Openly give, receive, and incorporate feedback from attending, 
fellows, and other ED staff. Self-evaluate strengths and areas of 
improvement. 

o Follow-up on patients 




For your education, follow-up on patients with challenging, 
questionable, or unclear diagnoses (including admitted and 
discharged patients, diagnostic dilemmas, and outstanding cultures). 
Communicate your follow-up with co-workers and attendings who 
participated in the care. As a senior resident, volunteer to help the 
attending with morning follow-up labs. 

Systems-Based Practice Demonstrate and 

1) Respect and clearly communicate with the different 





awareness of and responsiveness to the 
larger context and system of healthcare 
and effectively utilize system resources to 
provide optimal care 

members of the medical team. In particular when giving or 
receiving sign-out be sure to include face-to-face 
interaction with the patient. 
2) ChartingComplete and sign all resident sections of the 
chart (including procedure notes, and medication order 
sheet). 
3) Advocate on behalf of your patients. Try to understand 
their life circumstances, and how and why it is they came to 
use the ED. 


o Awareness of greater ED and 
hospital environment 
. Waiting room, acuity 
of pts waiting 






Be able to prioritize 
and efficiently 
manage all patients 
assigned to you. 
Look at the acuity 
level of all patients 
assigned to you; 
prioritize and 
efficiently multi-task 
(with guidance from 
an attending or 
fellow). 

Be able to prioritize 
and efficiently 
manage all patients 
assigned to you. 
Look at the acuity 
level and wait times 
of all patients in the 
ED to see if resident 
reassignment is 
needed. 

In addition to 
managing your 
primary patients, 
help the attending 
or fellow manage 
the ED. Watch the 
tracking board and 
waiting room to see 
if resident 
reassignment is 
needed, and teach 
junior residents 
multi-tasking skills. 




Pediatric Residents Goals and Objectives 

 

PGY-1 

PGY-2 

PGY-3 

Professionalism Commitment to carrying 
out professional responsibilities, adherence 
to ethical principles, and sensitivity to a 
diverse patient population. 

Be professional and ethical in your interactions with patients, 
families, and co-workers. Through your training, these behaviors 
should increase; a senior resident should be an example and teacher 
to junior residents. 

Medical Knowledge Application of 
established and evolving biomedical, 
clinical, and scientific knowledge to patient 
care. 

Familiarize yourself with sections III. Common Signs and Symptoms, 
IV. Common Conditions, and V. Diagnostic Testing in the document 
Part II. Educational Goals and Objectives for the ED at CHRCO prior 
to each time you rotate at the CHRCO ED; seek knowledge in these 
topics through clinical experience and self-directed reading. Give 
special attention towards learning topics with which youve not had 
experience or are unfamiliar. 

o Knowledge of differential 
diagnoses 
o PEM-specific knowledge of 
diseases 




Gain a basic 
knowledge of 
sections III-IV 
through clinical 
experiences, 
didactics, and self-
directed reading. 

Begin to gain 
advanced knowledge 
of other topics in 
sections III-IV. Have 
an advanced 
knowledge of the 
differentials for fever 
in various age 
groups, abdominal 
pain, respiratory 
distress, and the ill-
appearing infant. 

Have an advanced 
knowledge of 
sections III-IV. 

o Choosing diagnostic tests and 
making management plans 
o Synthesis of knowledge 




Basic knowledge of 
section V. Always 
independently 
formulate a 
diagnostic and 
management plan. 
Implement that plan 
after receiving 
guidance from the 
attending or fellow. 

Work towards an 
advanced knowledge 
of section V. Always 
independently 
formulate a 
diagnostic and 
management plan. 
Develop comfort in 
implementing these 
plans with minimal 
guidance from 
attending and 
fellows. 

Advanced 
knowledge of 
section V. 
Demonstrate to 
attendings and 
fellows the ability to 
independently 
synthesize clinical 
information, choose 
diagnostic tests and 
create management 
plans. 

Patient Care Treat health problems and 
promote health in a compassionate, 
appropriate, and effective manner. 

 

o Initial assessment of vitals and 
severity of illness 




Prior to obtaining history always make an initial assessment of vitals 
and severity of illness. Reassess pertinent abnormal vital signs 
during physical exam. 

 

Immediately 
recognize severely ill 
patients and bring 
an attending or 
fellow to the 
bedside. Recognize 

Recognize 
moderately and 
severely ill patients 
and initiate 
management plans. 
Involve the fellow or 

Independently 
recognize and treat 
moderately and 
severely ill patients. 
Alert the fellow or 
attending of the 




moderately ill 
patients and under 
the guidance of a 
fellow or attending 
initiate management 
plans early. 
Recognize that this 
may need to be prior 
to obtaining 
comprehensive Hx 
and PE. 

attending early in the 
management of the 
patient. 

presence of severely 
ill patients, and 
what your plan of 
management has 
been/will be. 

o Systematic approach to 
History (Hx) and physical 
exam (PE) 




Develop a systematic approach to a directed Hx and PE. Junior 
residents should ask for guidance from an attending, fellow, or 
senior resident in improving skills at the bedside. 

o Continuing 
management/reassessment 
of patients 




Continually reassess 
the clinical status of 
all your patients (in 
particular after tests 
results are available, 
clinical interventions 
have been done, or a 
long period of 
waiting). 

Improve in your 
ability to continually 
reassess the clinical 
status of all your 
patients (in particular 
after tests results are 
available, clinical 
interventions have 
been done, or a long 
period of waiting). 

In addition to 
reassessing ones 
own patients, senior 
residents should be 
mindful of the 
whole ED 
environment and 
remind and help 
junior residents 
reassess and update 
their patients. 

o Leading a 
resuscitation/trauma 




Attend all pediatric 
resuscitations and 
traumas (as clinical 
work allows) to be a 
member of the 
resuscitation team, 
and to watch how 
the team leader is 
running the 
resuscitation. 

You will be assigned 
the role of 
RESUSCITATION 
resident. Take the 
lead and be able to 
systematically 
organize, lead, and 
implement a plan 
during a pediatric 
resuscitation with 
the guidance of an 
attending or fellow. 

You will be assigned 
the role of 
RESUSCITATION 
resident. Take the 
lead and be able to 
systematically 
organize, lead, and 
implement a plan 
during a pediatric 
resuscitation in an 
independent 
fashion using the 
attending as back-
up as needed. 

o Procedural skills 




Read about all procedures in Section II, V, and VI. 

 

Know how and begin 
to perform basic 
pediatric procedures 
under the guidance 
of staff, attending or 
fellow (urinary 
catheterization, IV 
placement, 
laceration repair, 
splinting, lumbar 
puncture, bag-valve 

Demonstrate 
performance of basic 
procedures (listed to 
the left) with minimal 
guidance from an 
attending or fellow. 
Begin to develop 
proficiency in 
remaining 
procedures in 
sections II,V, and VI. 

Be able to 
independently 
perform procedures 
in sections II, V, and 
VI with minimal 
guidance from the 
attending. 




mask ventilation, 
chest compressions) 

Interpersonal and Communication Skills 
Effectively team with and exchange 
information with patients, families, and 
other health professionals. 

1) Strive towards succinct, goal-directed, and courteous 
communications with your team of co-workers and 
consultants. 
2) Continually communicate with families so that they 
understand their experience in the ED. They should 
always know who you are, what they plan is, and what 
they are waiting for. If they are discharged, you 
should give an understanding of their probable 
diagnosis, its management, follow-up care, and signs 
that they should return to the ED. 


o Presenting to an 
attending/fellow 




Develop a 
systematic approach 
towards patient 
presentation that 
includes Hx, PE, 
discussion of 
differential and 
management 
options. 

Improve upon your 
systematic approach 
by mastering the 
presentation of 
pertinent elements. 

Succinctly present 
the pertinent Hx, 
PE, differential and 
management with 
minimal need for an 
attending or fellow 
to clarify or 
intervene. 

o Calling consults 




Call consultants only 
after discussion with 
an attending or 
fellow. When calling 
a consult understand 
the indication, make 
a list of the clinical 
questions, and give 
the appropriate 
patient information. 

Let an attending or 
fellow know when 
you are going to call 
a consultant. With 
help from the 
attending, 
understand the 
indication for 
consultation, 
formulate and 
present an initial 
plan, and give the 
pertinent 
information 
succinctly. 

Let an attending or 
fellow know when 
you are going to call 
a consultant. Be 
able to 
independently 
formulate a 
comprehensive plan 
prior to calling the 
consultant and give 
the pertinent 
information 
succinctly. 

Practice-Based Learning and Improvement 
Investigate and evaluate ones own patient 
care, appraisal and assimilation of scientific 
evidence, and improvements in patient 
care. 

Use and appraise the literature to add to and enhance clinical 
management. 

 

o Seek out feedback and self-
evaluate 
o Receive and incorporate 
feedback 




Openly give, receive, and incorporate feedback from attending, 
fellows, and other ED staff. Self-evaluate strengths and areas of 
improvement. 

o Follow-up on patients 




For your education, follow-up on patients with challenging, 
questionable, or unclear diagnoses (including admitted and 
discharged patients, diagnostic dilemmas, and outstanding cultures). 
Communicate your follow-up with co-workers and attendings who 
participated in the care. As a senior resident, volunteer to help the 
attending with morning follow-up labs. 




Systems-Based Practice Demonstrate and 
awareness of and responsiveness to the 
larger context and system of healthcare 
and effectively utilize system resources to 
provide optimal care 

1) Respect and clearly communicate with the different 
members of the medical team. In particular when 
giving or receiving sign-out be sure to include face-to-
face interaction with the patient. 
2) ChartingComplete and sign all resident sections of 
the chart (including procedure notes, and medication 
order sheet). 
3) Advocate on behalf of your patients. Try to 
understand their life circumstances, and how and why 
it is they came to use the ED. 


o Awareness of greater ED and 
hospital environment 
. Waiting room, acuity 
of pts waiting 






Learn the basics of 
managing more than 
one patient at a 
time. Look at the 
acuity level of all 
patients assigned to 
you; prioritize and 
efficiently multi-task 
(with guidance from 
an attending or 
fellow). 

Be able to prioritize 
and efficiently 
manage all patients 
assigned to you. 
Look at the acuity 
level and wait times 
of all patients in the 
ED to see if resident 
reassignment is 
needed. 

In addition to 
managing your 
primary patients, 
help the attending 
or fellow manage 
the ED. Watch the 
tracking board and 
waiting room to see 
if resident 
reassignment is 
needed, and teach 
junior residents 
multi-tasking skills. 



 


Family Practice Residents Goals and Objectives 

 

PGY-1 

PGY-2 

PGY-3/4 

Professionalism Commitment to carrying 
out professional responsibilities, adherence 
to ethical principles, and sensitivity to a 
diverse patient population. 

Be professional and ethical in your interactions with patients, 
families, and co-workers. Through your training, these behaviors 
should increase; a senior resident should be an example and 
teacher to junior residents. 

Medical Knowledge Application of 
established and evolving biomedical, 
clinical, and scientific knowledge to patient 
care. 

Familiarize yourself with sections III. Common Signs and Symptoms, 
IV. Common Conditions, and V. Diagnostic Testing in the document 
Part II. Educational Goals and Objectives for the ED at CHRCO 
prior to each time you rotate at the CHRCO ED; seek knowledge in 
these topics through clinical experience and self-directed reading. 
Give special attention towards learning topics with which youve not 
had experience or are unfamiliar. 

o Knowledge of differential 
diagnoses 
o PEM-specific knowledge of 
diseases 




Gain a basic 
knowledge of 
sections III-IV 
through clinical 
experiences, 
didactics, and self-
directed reading. 

Begin to gain 
advanced knowledge 
of other topics in 
sections III-IV. Have 
an advanced 
knowledge of the 
differentials for fever 
in various age 
groups, abdominal 
pain, respiratory 
distress, and the ill-
appearing infant. 

Begin to gain 
advanced 
knowledge of other 
topics in sections 
III-IV. Have an 
advanced 
knowledge of the 
differentials for 
fever in various age 
groups, abdominal 
pain, respiratory 
distress, and the ill-
appearing infant. 

o Choosing diagnostic tests and 
making management plans 
o Synthesis of knowledge 




Basic knowledge of 
section V. Always 
independently 
formulate a 
diagnostic and 
management plan. 
Implement that plan 
after receiving 
guidance from the 
attending or fellow. 

Basic knowledge of 
section V. Always 
independently 
formulate a 
diagnostic and 
management plan. 
Implement that plan 
after receiving 
guidance from the 
attending or fellow. 

Work towards an 
advanced 
knowledge of 
section V. Always 
independently 
formulate a 
diagnostic and 
management plan. 
Develop comfort in 
implementing 
these plans with 
minimal guidance 
from attending and 
fellows. 

Patient Care Treat health problems and 
promote health in a compassionate, 
appropriate, and effective manner. 

 

o Initial assessment of vitals and 
severity of illness 




Prior to obtaining history always make an initial assessment of vitals 
and severity of illness. Reassess pertinent abnormal vital signs 
during physical exam. 

 

Immediately 
recognize severely ill 
patients and bring an 
attending or fellow 

Immediately 
recognize severely ill 
patients and bring an 
attending or fellow to 

Recognize 
moderately and 
severely ill patients 
and initiate 




to the bedside. 
Recognize 
moderately ill 
patients and under 
the guidance of a 
fellow or attending 
initiate management 
plans early. 
Recognize that this 
may need to be prior 
to obtaining 
comprehensive Hx 
and PE. 

the bedside. 
Recognize 
moderately ill 
patients and under 
the guidance of a 
fellow or attending 
initiate management 
plans early. 
Recognize that this 
may need to be prior 
to obtaining 
comprehensive Hx 
and PE. 

management plans. 
Involve the fellow 
or attending early 
in the management 
of the patient. 

o Systematic approach to 
History (Hx) and physical exam 
(PE) 




Develop a systematic approach to a directed Hx and PE. Junior 
residents should ask for guidance from an attending, fellow, or 
senior resident in improving skills at the bedside. 

o Continuing 
management/reassessment of 
patients 




Continually reassess 
the clinical status of 
all your patients (in 
particular after tests 
results are available, 
clinical interventions 
have been done, or a 
long period of 
waiting). 

Continually reassess 
the clinical status of 
all your patients (in 
particular after tests 
results are available, 
clinical interventions 
have been done, or a 
long period of 
waiting). 

Improve in your 
ability to 
continually 
reassess the clinical 
status of all your 
patients (in 
particular after 
tests results are 
available, clinical 
interventions have 
been done, or a 
long period of 
waiting). 

o Leading a 
resuscitation/trauma 




Attend all pediatric 
resuscitations and 
traumas (as clinical 
work allows) to be a 
member of the 
resuscitation team, 
and to watch and 
learn how the team 
leader is running the 
resuscitation. 

Attend all pediatric 
resuscitations and 
traumas (as clinical 
work allows) to be a 
member of the 
resuscitation team, 
and to watch and 
learn how the team 
leader is running the 
resuscitation. 

Attend all pediatric 
resuscitations and 
traumas (as clinical 
work allows) to be 
a member of the 
resuscitation team, 
and to watch and 
learn how the team 
leader is running 
the resuscitation. 

o Procedural skills 




Read about all procedures in Section II, V, and VI. 

 

Know how and begin 
to perform basic 
pediatric procedures 
under the guidance 
of staff, attending or 
fellow (urinary 
catheterization, IV 
placement, 
laceration repair, 
splinting, lumbar 
puncture, bag-valve 

Know how and begin 
to perform basic 
pediatric procedures 
under the guidance 
of staff, attending or 
fellow (urinary 
catheterization, IV 
placement, laceration 
repair, splinting, 
lumbar puncture, 
bag-valve mask 

Demonstrate 
performance of 
basic procedures 
(listed to the left) 
with minimal 
guidance from an 
attending or fellow. 
Begin to develop 
proficiency in 
remaining 
procedures in 




mask ventilation, 
chest compressions) 

ventilation, chest 
compressions) 

sections II,V, and 
VI. 

Interpersonal and Communication Skills 
Effectively team with and exchange 
information with patients, families, and 
other health professionals. 

1) Strive towards succinct, goal-directed, and courteous 
communications with your team of co-workers and 
consultants. 
2) Continually communicate with families so that they 
understand their experience in the ED. They should always 
know who you are, what they plan is, and what they are 
waiting for. If they are discharged, you should give an 
understanding of their probable diagnosis, its 
management, follow-up care, and signs that they should 
return to the ED. 


o Presenting to an 
attending/fellow 




Develop a systematic 
approach towards 
patient presentation 
that includes Hx, PE, 
discussion of 
differential and 
management 
options. 

Improve upon your 
systematic approach 
by mastering the 
presentation of 
pertinent elements. 

Succinctly present 
the pertinent Hx, 
PE, differential and 
management with 
minimal need for 
an attending or 
fellow to clarify or 
intervene. 

o Calling consults 




Call consultants only 
after discussion with 
an attending or 
fellow. When calling 
a consult understand 
the indication, make 
a list of the clinical 
questions, and give 
the appropriate 
patient information. 

Call consultants only 
after discussion with 
an attending or 
fellow. When calling 
a consult understand 
the indication, make 
a list of the clinical 
questions, and give 
the appropriate 
patient information. 

Let an attending or 
fellow know when 
you are going to 
call a consultant. 
With help from the 
attending, 
understand the 
indication for 
consultation, 
formulate and 
present an initial 
plan, and give the 
pertinent 
information 
succinctly. 

Practice-Based Learning and Improvement 
Investigate and evaluate ones own patient 
care, appraisal and assimilation of scientific 
evidence, and improvements in patient 
care. 

Use and appraise the literature to add to and enhance clinical 
management. 

 

o Seek out feedback and self-
evaluate 
o Receive and incorporate 
feedback 




Openly give, receive, and incorporate feedback from attending, 
fellows, and other ED staff. Self-evaluate strengths and areas of 
improvement. 

o Follow-up on patients 




For your education, follow-up on patients with challenging, 
questionable, or unclear diagnoses (including admitted and 
discharged patients, diagnostic dilemmas, and outstanding 
cultures). Communicate your follow-up with co-workers and 
attendings who participated in the care. 

Systems-Based Practice Demonstrate and 
awareness of and responsiveness to the 

1) Respect and clearly communicate with the different 
members of the medical team. In particular when giving or 





larger context and system of healthcare and 
effectively utilize system resources to 
provide optimal care 

receiving sign-out be sure to include face-to-face 
interaction with the patient. 
2) ChartingComplete and sign all resident sections of the 
chart (including procedure notes, and medication order 
sheet). 
3) Advocate on behalf of your patients. Try to understand 
their life circumstances, and how and why it is they came 
to use the ED. 


o Awareness of greater ED and 
hospital environment 
. Waiting room, acuity 
of pts waiting 






Learn the basics of 
managing more than 
one patient at a 
time. Look at the 
acuity level of all 
patients assigned to 
you; prioritize and 
efficiently multi-task 
(with guidance from 
an attending or 
fellow). 

Be able to prioritize 
and efficiently 
manage all patients 
assigned to you. 
Look at the acuity 
level of all patients 
assigned to you; 
prioritize and 
efficiently multi-task 
(with guidance from 
an attending or 
fellow). 

Be able to prioritize 
and efficiently 
manage all patients 
assigned to you. 
Look at the acuity 
level of all patients 
assigned to you; 
prioritize and 
efficiently multi-
task. 



 


Part II. 

EDUCATIONAL GOALS AND OBJECTIVES FOR THE CHILDRENS HOSPITAL OAKLAND 
EMERGENCY DEPARTMENT 

 

FOR Pediatric Interns and Residents, Visiting Residents, and Subspecialty Fellows 

The rotation in the Emergency Department (ED) at CHO will provide experiences in all of the following categories. 
Objectives listed in regular type are to be achieved by all residents after they have completed rotations through 
the ED. Interns are expected to achieve general familiarity, while second and third year residents, Pediatric 
Emergency Medicine fellows  to achieve progressively more comprehensive knowledge of the listed areas over 
the senior years of training. Familiarity with the objectives in italics, while desirable for all residents, is an absolute 
requirement for the Pediatric Emergency Medicine subpsecialty resident (fellow). All clinical and administrative 
activities will be performed under direct supervision of the on-site Pediatric Emergency Medicine attending 
physician. 

I. Emergency Medical Services for Children : EMS-C 

II. Resuscitation and Stabilization of Patients in the Emergency Department 
III. Common Signs and Symptoms 
IV. Common Conditions 
V. Diagnostic Testing 
VI. Monitoring and Therapeutic Modalities 
VII. Management and Decision-Making 
VIII. Teamwork and Consultation 
IX. Patient Support and Advocacy 
X. Financial Issue and Cost Control 
XI. Medical Records 


 

I. Emergency Medical Services for Children : EMS-C 

Understand the basic principles of emergency medical services for children, including the role of the 
primary care provider, prehospital care systems, regional trauma systems. 

Objectives: 

A. Describe the organization of the Alameda County, Bay Area EMS-C system, including: 
. Pre-hospital care: access, training, and limitations of providers; transportation systems, the effect 
of time/distance on response 
. Availability of trauma and other center capable of providing care for critically ill children 
. Facilities for inter-hospital transport 
. How to arrange transport to another facility (including timing with respect to the condition of the 
patient, appropriate mode of transport, and communication between facilities 
. Disaster preparedness: role of the pediatrician in preparing for and responding to disasters 
. Optional opportunity to schedule ride-alongs (interns especially encouraged) with local EMTs 
. Familiarity with: 
. ED Policy and Procedure Manual Chapter 9: Prehospital 
. ED Policy and Procedure Manual Chapter 12: Transfer 
. ED Policy and Procedure Manual Chapter 7: Disaster/Safety Policies 



. Elective experience for the fellow at the EMS office with Dr. Jim Pointer, ALCO EMS 
Medical Director; 2 weeks of participation in ambulance ride-alongs, EMS research 
group, teaching activities and evaluation of EMTs and paramedics 
B. Explain the unique medical-legal issues in providing emergency care, including: 
. Caring for patients with no financial support 
. Consent for urgent medical care of minors, including special circumstances (i.e. rape, abuse, 
substance abuse, STDs) 
. Obligations of the emergency physician to provide/arrange followup care 
. Physician responsibilities and COBRA regulations regarding inter-hospital patient transfer 
. Medical examiner/coroner cases 
. Familiarity with: 
. Title XXII and ED Policy and Procedure Manual, Chapter 1: Purpose 
. ED Policy and Procedure Manual Chapter 19: Medical 
Records/Consent/Confidentiality 
. ED Policy and Procedure Manual Chapter 12: Transfer 
. ED Policy and Procedure Manual Chapter 20: Code Blue/Death 
. HIS Library item: Postmortem Protocol 
. Optional elective for fellows with Marva Furmidge, CHRCO Risk Manager 
C. Describe the equipment, staff training, and reference material needed to ensure office preparedness for 
emergencies 
. Reference Hodge et al article, AAP Committee on Office Preparedness statement. 
D. Discuss how principles of injury prevention apply to the role of EMS-C (i.e. in minimizing the impact of 
injury) 
. Reference Trauma article ( in the red packet), our participation in the CPSC surveys, 
bicycle helmet program etc.etc. 
II. Resuscitation and Stabilization of Patients in the Emergency Department 


Understand how to rapidly assess, resuscitate, and stabilize a critically ill or injured child in the ED setting. 

Objectives: 

 

A. Rapidly assess urgent patients 


 

. Recognize respiratory failure and/or shock 
. Formulate a diagnosis quickly, especially with respect to conditions which may need respiratory 
or cardiovascular support, other immediate intervention (i.e. tension pneumothorax, cerebral 
edema with impending herniation, cardiac tamponade) 
. Assist in evaluating and stabilizing the child with multiple trauma 
. Familiarity with: 
. ED Policy and Procedure Manual, Chapter 17, Medical and Nursing Protocols and 
Procedures 
. PALS or APLS providers (interns and residents, visitors) or instructors (fellows) 
. ATLS providers (fellows), supplemental trauma rotations (fellows) 
. Ongoing reviews with fellowship director, other attendings at twice-monthly ED staff 
conferences, HGH Wednesday morning conferences, chapter  by- chapter review of 
Review for Textbook of Pediatric Emergency Medicine, Sharma S and Wang V (eds), 
Lippincott Philadelphia 2000 over the academic year (fellows) 


 

B. Establish and manage airway for infant, children, and teens 


 

. Demonstrate proficiency in: bag-valve-mask ventilation, nasal and oral airways, endotracheal 
intubation, mechanical ventilation, cognizance of cervical spine protection during the airway 
management of trauma patients, oro- and nasogastric tube placement 



. Know indications for and technique of nasotracheal intubation, emergency cricothyrotomy, 
needle thoracostomy 
. Familiarity with same sections of the ED P&P manual, APLS or PALS, ATLS; in addition 
residents will have gleaned this experience during other rotations (PICU, NICU, trauma 
rotations, ED rotations off site); policy requires ED attending or fellow to perform endotracheal 
intubation on all patients requiring this procedure. The fellow will have also had a required 4 
week rotation and possibly some optional rotations in pediatric anesthesia to supplement training. 


 

C. Identify priorities for vascular access; establish access; perform fluid resuscitation 


 

. Demonstrate proficiency in the cannulation of peripheral veins, intraosseous needle insertion, 
umbilical vessel cannulation 
. Explain indications and describe technique for: central venous access and arterial access 
. Familiarity with same sections of the ED P&P manual, APLS or PALS and ATLS; experience 
during other rotations for the residents; procedure labs twice yearly for all houseofficers, to take 
place during noon conference given by the ED attendings. 


 

 

D. Demonstrate proficiency at cardiopulmonary resuscitation 


 

. Obtain certification as PALS provider (see above) 
. Direct resuscitation efforts in mock codes and actual emergency situations 
. Understand the pharmacology of the drugs used in resuscitation. 
. Officiate (run) mock codes for and with colleagues; text for case templates: Handbook of 
Pediatric Mock Codes, Roback MG, Teach SJ, First LR, Fleisher GR (eds), Mosby, St. Louis, 1998 


 

III. Common Signs and Symptoms 


Understand how to evaluate and manage common signs and symptoms in infants, children, and adolescents 
presenting to the ED. Objectives: 

. Perform an ED appropriate problem-oriented history and physical 
. Document pertinent positive and negative findings on paper ED record 
. Formulate a differential diagnosis, with appropriate prioritization, recognizing patients with 
possible life-threatening conditions 
. Describe indications for admissions to the ward or PICU or transfer to another facility 
. Arrange appropriate followup, inform primary physicians 


List of Signs and Symptoms which Present Emergently 

1. General: Septic or ill-appearing infant/child, unexplained crying, fever, hypothermia, ALTE, SIDS, weight loss, 
behaviorally disturbed child, dehyration, the child suspected to have abused or neglected. 

2. Allergy/Immunology: Acute allergic/anaphylactoid/anaphylactic reactions 

3. Cardiorespiratory: Apnea, respiratory distress, tachypnea, respiratory failure, cyanosis, tachycardia or other 
arrhythmias, cough, wheezing, stridor, chest pain, palpitations, foreign body aspiration, hyper- and hypo-tension 

4. Dermatologic: skin rashes, hair loss, itching, burns, graft-versus-host reactions 

5. EENT: epistaxis, sore throat, earache, ear discharge, hearing loss, red eye, abnormal vision, eye pain 

6. Endocrine: DKA, new onset diabetes, thyroid storm sx, congenital adrenal hyperplasia sx 

7. GI: abdominal pain, distension, diarrhea, vomiting, constipation, ingestion of foreign body, GI bleeding, jaundice 


8. GU/Renal: edema, changes in urination, bloody or discolored urine, groin or scrotal mass, pain, 

9. GYN: menstrual problems, vaginal bleeding or other discharge 

10. Heme/Onc: abnormal bleeding, petechiae, masses, organomegaly, lymphadenopathy, pallor, fever or illness in 
the immunocompromised child 

11. Musculoskeletal: limb pain, limp, arthralgia, joint swelling, inability to move an extremity, trauma to any of 
these areas 

12. Neurologic: ataxia, coma, lethargy, confusion, syncopal spells seizures, headache, weakness or paralysis, 
bulging fontanel, stiff neck, head injury, dizziness 

13. Psychiatric: behavior disturbance, suicidal ideation and attempts, depression, anxiety 

14. Surgery/trauma: lacerations, burn, multiple major and minor trauma; cross-referenced surgical conditions 
under GI, GU especially 

 

. ED Policy and Procedure Manual, Chapter 17: Medical and Nursing Protocols and Procedures 
. Hospital wide clinical Practice guidelines  all on file in the ED core in labeled binders; also available in Magic 
Office library 


 

 

IV. Common Conditions 


Understand how to manage common illnesses and injuries presenting emergently (coordinate with previous 
section). Objectives: 

. Discuss the pathophysiologic basis of the disease or injury 
. Discuss and implement initial rapid assessment and stabilizing treatment, including specialized 
examinations when indicated 
. Make a decision regarding disposition from the ED 
. Discuss the appropriate use of consultants and the role of the generalist in management. 


 

List of Common Diagnoses which Present Emergently 

1. Allergy/Immunology: asthma, anaphylaxis, angioedema, serum sickness, HIV/AIDS, acute illness in the 
immunocompromised child 

2. Cardiovascular: acute hyper-, hypo-tension, CHF, pericarditis, dysrhythmias, shock, Kawasakis, acute illness in a 
patient with CHD, endocarditis, myocarditis, rheumatic fever 

3. Dermatology: acute drug reactions, contact dermatitis, bacterial,viral,fungal infections of the skin and hair, 
infestations, cutaneous manifestations of systemic illness 

4. Endocrinology: diabetes and DKA, hypoglycemia, calcium metabolism problems, electrolyte abnormalities, acute 
illness in a child with underlying endocrine/metabolic disease, thyroid storm, congenital adrenal hyperplasia, 
inborn errors of metabolism 


5. GI/Surgical: Acute abdomen, peritonitits, bowel obstruction, ileus, appendicitis, volvulus, malrotation, pyloric 
stenosis, peptic ulcer disease, constipation, biliary tract disease, inflammatory bowel disease, upper and lower GI 
bleeding, pancreatitis, foreign body in the GI tract 

6. GU/Renal: ARF, hematuria, proteinuria, UTI, phimosis, balanitis, paraphimosis, testicular torsion, epididymitis, 
STD, edema, nephrolithiasis, acute illness in child with transplanted kidney or on chronic dialysis 

7. GYN: dysfunctional vaginal bleeding, vaginal discharge, PID, pregnancy (intrauterine, ectopic, abortion) 

8. Heme/Onc: sickle cell vasoocclusive crisis, aplastic crisi, sequestration crisis, acute chest syndrome, fever in a 
child with sickle cell disease or leukemia, anemia, thrombocytopenia, coagulopathy, hemophilia, tumors-masses 

9. Infectious disease: otitis media/externa, pharyngitis, cervical adenitis, peritonsillar abscess, retropharyngeal 
abscess, cellulitis (buccal/orbital/periorbital), sinusitis, meningitis, encephalitis, sepsis/bacteremia/fever without a 
source, osteomyelitis 

10. Neurologic: ALOC, migraine, muscle contraction headache, shunt malfunction/infection, increased ICP 

11. Ophthalmologic: corneal abrasion, conjunctivitis, ocular foreign body, pener\trating trauma to the globe, 
hyphema 

12. Otolaryngology: epistaxis, foreign body aspiration, epiglottitis, croup, tracheitis 

13. Orthopedic: gait disturbance, sprains, strains, fractures  nondisplaced and those requiring reduction, arhritis, 
bone and joint infection, common dislocations, SCFE, Osgood Schlatter 

14. Respiratory: resp failure, pneumonia, asthma, status asthmaticus and complications, pneumothorax, 
bronchiolitis, pleural effusion, smoke inhalation, acute illness in a child with CF, BPD, severe asthma 

15. Surgical/Trauma: burns, closed head injury, skull fractures, soft tissue injuy: lacerations, abrasions, contusions, 
dental injuries, other major and minor trauma 

16. Toxicology/Environmental: ingestion/poisoning with unknown substance, bites and stings, submersion, heat 
and cold injuries 

17. Psychiatric: depression, suicide attempt/ideation, combative patient, conversion reaction/panic attacks 

18. Social: child abuse, neglect, sexual abuse, rape, substance abuse, domestic violence 

. Textbooks and formats mentioned in the previous sections will also apply here 


 

V. Diagnostic Testing 


Understand how to use and interpret laboratory, imaging, and other commonly used studies, diagnostic 
procedures in the ED. Objectives: 

. Explain the indications and limitations and be aware of age-appropriate normals 
. Understand the statistical aspects of lab tests commonly ordered: sensitivity, specificity, 
positive and negative predictive values, etc. to assess utility of individual tests in specific 
clinical situations 
. Recognize cost utilization issues 



. Understand the benefits and disadvantages of family presence during procedures 
. Independently interpret results in the context of a particular patient; know therapeutic options 
for correcting abnormal lab results 


 

ED laboratory studies 

. CBC, diff, plts, indices, ESR, CRP , coagulation studies 
. Rapid screens for bacterial, viral, fungal pathogens 
. Serologic tests for infection (monospot, VDRL, hepatitis, RSV, PCR) 
. Blood chemistries: lytes, ca, mag, glu 
. Blood gases  arterial, venous, capillary 
. Hepatic function tests 
. Renal function tests 
. Drug screens, and levels 
. Simple micro procedures: gram stains, CSF counts, UA 
. Pregnancy test (urine, serum) 
. ED Policy and Procedure Manual, Chapter 16: Lab/X-ray 
. Senior residents and fellows will assist the attending physician in following up lab results which 
require action, and will learn to appropriately document such activity on the HIS system 


 

Imaging and radiologic studies 

. Plain radiographs 
. Ultrasonography 
. CT scanning  contrast and without 
. Appropriate use of emergency echocardiography 
. ED Policy and Procedure Manual, Chapter 16: Lab/X-Ray 


 

Other studies and procedures 

. EKG 
. Vision 
. Peak flow 
. Lumbar Puncture 
. Urinary catheterization 
. ED Policy and Procedure Manual, Chapter 16: Lab/X-Ray 


 

 

VI. Monitoring and Therapeutic Modalities 


Understand the application of physiologic monitoring and special technology and treatment in the ED. 
Objectives: 

. Discuss indications, contraindications, complications 
. Demonstrate proper use and technique in children of varying ages 
. Interpret results of monitoring based on the method used 
. Hospital wide Sedation Policy and Procedure 


Monitoring techniques 

. Vital sign monitoring 
. Pulse oximetry 
. Capnometry/ end tidal CO2 
. ED Policy and Procedure Manual, Chapter 14: Equipment and supplies 


Treatments and Techniques 

. Universal precautions 



. Injury, wound (including lacerations, bites, crush, abrasions, etc.) and burn care 
. Gastrointestinal decontamination 
. Administration of nebulized medications 
. Splinting 
. Incision and drainage 
. Oxygen delivery systems 
. Pain management : methods for recognizing, evaluating pain; ASA classification system, topical, local, 
regional anesthesia; 
. Procedural sedation, appropriate use of narcotic and non-narcotic analgesics, other 
. Rapid Sequence Intubation 
. Restraints : behavioral and chemical, for procedures 
. Nonpharmacologic methods of pain control: distraction, humor therapy 


 

Hospital wide Policies on all these topics 

Third year residents and fellows will be expected to be Sedation Certified as per hospital-wide 
sedation committee credentialing. They will thus participate directly in the pain management and 
administration of procedural sedation for those patients requiring this in the ED. 

VII Management and Decision-Making 

Develop a logical and efficient approach to the care of emergency patients, applying principles of decision-
making and problem solving. Objectives: 

 

A. Demonstrate ability to prioritize care needs  perform accurate ED triage, including telephone triage; 
provide care to multiple patients, with varying levels of acuity: use appropriate timing of 
diagnostic/therapeutic interventions; adjust pace to ED patient acuity, volume, flow; 

B. Understand ones own limitations 
C. Act consistently and responsibly, adhering to professional standards of behavior 
D. Demonstrate respect for patient privacy and awareness of HIPAA regulations in both behavior and 
treatment of the patients medical record 
E. Maintain timely, appropriate, accurate medical records 
F. Be aware of quality control/quality improvement processes in the ED and when appropriate use the 
results to improve patient management. 


 

G. ED Policy and Procedures Manual, Chapter 21: Quality Assurance 

Medical Staff Bylaws 

A professionalism lecture series, started in August 2004, will cover monthly topics relevant to the 
above competencies. Attendance is required for all interns, residents, and fellows. All subspecialty 
fellows (not only the one in the ED) will be required to attend evening sessions, some of which will 
focus on the very same issues, quarterly during the academic year. 

 

All interns, residents, fellows must be familiar with HIPAA regulations as part of Hospital Policy 

 

VIII. Teamwork and Consultation 


Understand how to function as part of an interdisciplinary team in the ED 


Objectives: Participate effectively in the patient care team (nurses, clerical staff, financial workers, 
attending physicians, trauma team/ surgeons, residents, respiratory therapists, social workers, etc.); 

Use consultants appropriately and communicate effectively with them. 

Serve as pediatric consultant to primary care providers and specialists who manage children in the ED 

ED Policy and Procedure Manual Chapter 10: Admit/Discharge 

ED Policy and Procedure Manual, Chapter 18: Consultation 

Trauma Service Policies and Procedures 

See also Medical Staff By-Laws 

Professionalism lecture series monthly at noon, for all interns, residents and fellows, as well as a 
separate quarterly evening meeting on more expanded versions of these topics for all subspecialty 
fellows 

IX. Patient Support and Advocacy 


Understand how to provide sensitive support to families and patients with acute illness and injury, arrange 
for on-going support and/or preventive services as needed 

 

A. Listen to concerns of patients and families 
B. Deal with them in a non-judgmental, culturally-sensitive manner which conveys warmth and caring 
C. Identify risk factors for the child and family, even outside the scope of the ED visit 
D. Deal with the difficult parent or child 
E. Demonstrate sensitivity in dealing with dying or deceased children and their families 
F. Explain to the family the role of the PMD, supporting the multilevel provision of healthcare 
G. Enlist parents support in the care of their own child after discharge  they should be understanding 
of, and invested in this process 
H. Be familiar with the problems of indigent families seeking care 
I. Identify and try to prevent problems in ones own community 


ED Policy and Procedure Manual, Chapter 19: Medical records, Consent, confidentiality 

ED Policy and Procedure Manual, Chapter 22: Patients Rights 

Professionalism lecture series mentioned above 

X. Financial Issue and Cost Control 


Understand key aspects of cost, billing, reimbursement issues in the ED 

A. Identify the general cost range for diagnostic and therapeutic interventions in the ED; utilize these 
appropriately with an appreciation for the impact on medical outcome, the family, the service unit, 
the managed care or other providers 
B. Select medications with sensitivity to cost issues 
C. Practice appropriate utilization of Consultant 
D. Participate in billing/managed care routines required of providers in the ED facility, showing attention 
to detail, accuracy, documentation 
E. Be familiar with principles of various types of insurance coverage as it applies to the ED visit 
F. Be sensitive to the financial constraints of patients when deciding followup, disposition 
G. Every other month Administrative Seminars for ED physician and nursing managerial staff 



 

XI. Medical Records 


Maintain accurate, timely, legally appropriate medical records in the ED setting 

. H&P appropriate for the condition 
. Problem list and final diagnoses 
. Plan 
. Detailed procedure notes for those done in the ED 
. Accurate, timed, signed record of when medications are ordered, given in the ED 
. Results of any diagnostic studies available during ED visit 
. Condition on transfer or discharge from the ED 
. Condition at taking over the patient from another physician 
. Evidence of appropriate discharge instructions 
. Communicate effectively in writing and over the phone with referring and consulting, and primary 
physicians. 


ED Policy and Procedure Manual, Chapter19: Medical Records/Consent/Confidentiality 

ED Policy and Procedure Manual, Chapter 10: Admit/ Discharge 

ED Policy and Procedure Manual, Chapter 12: Transfer 

Hospital wide discharge information sheets, ED/UCC specific such sheets. 

 

 

 

 

 

 

 

 

 

 

Part II: Original AJSaulys 6-04, revised 8-09 CHRCO ED Education Committee 


